Basic Information
| Provider Information | |||||||||
| NPI: | 1043738271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LISA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CTRS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCANLON | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | LISA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1601 SW ARCHER RD | ||||||||
| Address2: | RECREATION THERAPY 117C | ||||||||
| City: | GAINSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 3523746094 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 SW ARCHER AVE | ||||||||
| Address2: | |||||||||
| City: | GAINSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523761611 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2017 | ||||||||
| LastUpdateDate: | 09/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225800000X | CTRS63772 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreation Therapist |
No ID Information.